Development of the PLIF and TLIF Techniques

Authors: J. Šrámek 1,2;  V. Jirsák 3;  M. Barna 4;  P. Nesnídal 4
Authors‘ workplace: Klinika ProSpine, Bogen, Spolková republika Německo2Fakulta biomedicínského inženýrství ČVUT, Kladno 1;  Fakulta stavební ČVUT v Praze 3;  Spondylochirurgické oddělení, FN v Motole, Praha 4
Published in: Cesk Slov Neurol N 2010; 73/106(5): 492-496
Category: Review Article


PLIF (posterior lumbar interbody fusion) and TLIF (transforaminal lumbar interbody fusion) are surgical techniques employed in cases of degenerative lumbar spinal disorders. They involve a surgical approach to the area of the lumbar intervertebral disc, its resection, and subsequent application of biocompatible material that will achieve fusion of two or more vertebrae. Briggs and Milligan published the PLIF method in 1944, involving application of ­cancellous bone grafts into the intervertebral space. Others, but mainly Cloward, further improved this technique. Bagby and Kuslich introduced a cylindrical stainless steel cage in the 1980’s, while Brantigan used a rectangular cage made of a polyether-etherketone polymer (PEEK), reinforced with carbon fiber. Implants of variable shape and materials ­characterize spinal fusion technique improvements in the 1990’s. Current trends work towards the develop­ment of a stand-alone cage without the need for posterior stabilization. Though the PLIF and TLIF techniques have been extensively used and verified, lumbar fusion may become unstable or even fail when biomechanical laws are neglected.

Key words:
posterior lumbar interbody fusion – transforaminal lumbar interbody fusion


1. Voháňka S, Mičánková Adamová B. Lumbální spinální stenóza a neurogenní klaudikace. Cesk Slov Neurol N 2009; 72/105(5): 405–417.

2. Jaslow IA. Intercorporal bone graft in spinal fusion after disc removal. Surg Gynecol Obstet 1946; 82: 215–222.

3. Cloward RB. The treatment of ruptured lumbar intervertebral discs by vertebral body fusion I. Indications, operative technique, after care. J Neurosurg 1953; 10(2): 154–168.

4. Briggs H, Milligan PR. Chip fusion of the low back following exploration of the spinal canal. J Bone Joint Surg 1944; 26A: 125–130.

5. Lin PM, Cautilli RA, Joyce MF. Posterior lumbar interbody fusion. Clin Orthop Relat Res 1983; 180: ­154–168.

6. Lin PM. Posterior lumbar interbody fusion technique: complications and pitfalls. Clin Orthop Relat Res 1985; 193: 90–102.

7. Lin GY, Wang YC, Young AY, Chao DY, Wang FH, Lin PJ. Bovine bone in posterior lumbar interbody ­fusion. Acta Neurol Sin 1993; 2: 134–137.

8. Kuslich SD, Ulstrom CL, Griffith SL, Ahern JW, Dowdle JD. The Bagby and Kuslich method of lumbar interbody fusion. History, technique, and 2-year follow-up results of a United States prospective, multicenter trial. Spine 1998; 23(11): 1267–1279.

9. Brislin B, Vaccaro AR. Advances in posterior lumbar interbody fusion. Orthop Clin North Am 2002; 33(2): 367–374.

10. Cloward RB. The anterior approach for removal of ruptured cervical disks. J Neurosurg 1958; 15(6): 602–617.

11. Kurtz SM, Edidin AA. Intervertebral body cages: Cervical and lumbar. In: Kurtz SM, Edidin AA. Spine technology handbook. USA: Elsevier 2006: 194–195.

12. Burkus J, Foley K, Haid R, Lehuec JC. Surgical interbody research group – radiographic assessment of interbody fusion devices: fusion criteria for anterior lumbar interbody surgery. Neurosurg Focus 2001; 10(4): E11.

13. Wood KB, Schwender JD. Lumbar intervertebral cages: Limitations and complications. Operat Tech ­Orthop 2000; 10(4): 320–324.

14. Brantigan JW, Niedre A, Toohey JS. The Lumbar I/F Cage for posterior lumbar interbody fusion with the variable screw placement system: 10-year results of a Food and Drug Administration clinical trial. Spine J 2004; 4(6): 681–688.

15. Steffee AD, Brantigan JW. The variable screw placement spinal fixation system: report of a prospective study of 250 patients enrolled in Food and Drug Administration clinical trials. Spine 1993; 18(9): 1160–1172.

16. Béland S. Polyketones. In: Béland S (ed). High performance thermoplastic resins and their composites. USA: Noyes publications 1990: 33–36.

17. Groeger R. Victrex, high performance PEEK polymers for medical components and instrumentation [online]. Dostupné z URL:

18. Hrabálek L, Rešková I, Bučil J, Vaverka M, Houdek M. Použití titanových a PEEKových implantátů při ALIF stand-alone u degenerativního onemocnění lumbosakrální páteře – prospektivní studie. Cesk Slov Neurol N 2009; 72/105(1): 38–44.

19. Blume HG. Unilateral posterior lumbar interbody fusion: simplified dowel technique. Clin Orthop Relat Res 1985; 193: 75–84.

20. Harms J, Jeszenszky D. The unilateral, transforaminal approach for posterior lumbar interbody fusion. Operat Orthop Traumatol 1998; 6: 88–99.

21. Moskowitz A. Transforaminal lumbar interbody fusion. Orthop Clin North Am 2002; 33(2): 359–366.

22. Vaněk, P Saur K. Transforaminální lumbo-sakrální mezitělová fúze (TLIF) s instrumentací: prospektivní studie s minimálně 20měsíčním sledováním. Cesk Slov Neurol N 2007; 70/103(5): 552–557.

23. Matějka J, Zeman J, Belatka J. Střednědobé výsledky 360° lumbální spondylodézy s použitím tantalové náhrady ploténky. Acta Chir Orthop Traum Cech 2009; 76: 388–393.

24. Bobyn JD, Stackpool G, Toh KK. Characteristics of bone ingrowth and interface mechanics of a new porous tantalum biomaterial. J Bone Joint Surg 1999; 81(5): 907–914.

25. Taylor BA, Riew KD. Clinical application of bone morphogenic protein in the spine. In: Kim DH, ­Vaccaro AR, Fessler RG (eds). Surgical techniques of spinal instrumentation: New York: Thieme Medical Publishers 2005: 1239–1249.

26. Meisel HJ, Schnöring M, Hohaus C, Minkus Y, Beier A, Ganey T et al. Posterior lumbar interbody fusion using rhBMP-2. Eur Spine J 2008; 17(12): 1735–1744.

27. Blumenthal SL, Ohnmeiss DD. Intervertebral cages for degenerative spinal diseases. Spine J 2003; 3(4): 301–309.

28. Folman Y, Shabat S, Gepstein R. B-twin expandable spinal spacer for posterior lumbar interbody stabilization: mechanical testing. J Surg Orthop Adv 2006; 15(4): 203–208.

29. Kim JW, Park HC, Yoon SH, Oh SH, Roh SW, Rim DC. Multi-center clinical study of posterior lumbar interbody fusion with the expandable stand-alone cage (Tyche cage) for degenerative lumbar spinal disorders. J Korean Neurosurg Soc 2007; 42(4): 251–257.

30. Leckie S, Wang J. Recent advances in nucleus pulposus replacement technology. Curr Orthop Pract 2009; 20(3): 222–226.

31. Errico TJ. Lumbar disc arthroplasty. Clin Orthop Relat Res 2005; 435: 106–117.

32. Schleicher P, Beth P, Ottenbacher A, Pflugmacher R, Scholz M, Schnake KJ et al. Biomechanical evaluation of different asymmetrical posterior stabilization. J Neurosurg Spine 2008; 9(4): 363–371.

33. Faundez AA, Mehbod AA, Wu C, Wu W, Ploumis A, Transfeldt EE. Position of interbody spacer in transforaminal lumbar interbody fusion: effect on ­3-dimensional stability and sagittal lumbar contour. J Spinal Disord Tech 2008; 21(3): 175–180.

34. Grant JP, Oxland TR, Dvorak MF. Mapping the structural properties of the lumbosacral vertebral end­plates. Spine 2001; 26(8): 889–896.

35. Abbushi A, Cabraja M, Thomale UW, ­Woiciechowsky C, Kroppenstedt SN. The influence of cage positioning and cage type on cage migration and fusion rates in patients with monosegmental posterior lumbar interbody fusion and posterior fixation. Eur Spine J 2009; 18(11): 1621–1628.

36. Perrin G. Treatment of lumbar spondylolisthesis and related unstable spinal lesions: the usefulness of PLIF with cages and dynamic interpedicular posterior fixation for circumferential arthrodesis and prevention of adjacent level degeneration. Proceedings of the 3rd World spine meeting; 2005 Jul 31-Aug 3; Rio de ­Janeiro, Brasil. Versailles: La fourmi a epsilon 2005.

37. Wendsche P. Restabilization in lumbar spine with the semirigid ISOLOCK device: mid-term results. Proceedings of the International 23rd course for percutaneous endoscopic spinal surgery and complementary minimal invasive techniques; 2005 Jan 27–28; Zurich, Switzerland. Zurich: Editiones Orthopaedicae Bethania 2005.

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